Cataract Surgical Services, Outcome and Barriers in Kericho, Bureti and Bomet Districts, Kenya

Abstract

Objective: To assess the cataract surgical coverage, outcome of cataract surgery and barriers to uptake of cataract surgical services. Setting: Kericho, Bureti and Bomet districts CES Project. Design: Cross-sectional population based survey using rapid assessment of avoidable blindness (RAAB) method. Participants: Fifty one clusters of 50 people aged 50 years or older were selected by probability proportionate to size sampling of clusters. Compact segment sampling was used to select households within the clusters. Two thousand fi ve hundred and forty six people were eligible for the survey of which 2419 (95%) were examined. Methods: Participants underwent a comprehensive ocular examination in their homes by an ophthalmologist. The visual acuity was measured using a tumbling E chart. The cause of visual impairment was established. Those who had undergone cataract surgery were questioned about the details of the operation and their satisfaction with the surgery. Those who were visually impaired from cataract were asked why they had not gone for surgery. Results: Cataract was found to be the main cause of blindness (42.9%) and visual impairment (42.7%) in those aged 50 years and older. The cataract surgical coverage was high, with 87.2% of those with bilateral cataract who needed surgery having had surgery at V/A<3/60. The quality of surgery was of concern with 20.7% of the 222 eyes that had undergone cataract surgery having a best corrected vision of <6/60. The main barriers to cataract surgery were cost and lack of awareness. Conclusions: The cataract surgical coverage in Kericho, Bureti and Bomet districts is high. The outcome of surgery is below the WHO standard and needs improvement